Dysrhythmias/Conduction prob
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| Define dysrhythmia | disorder with formation/conduction of electrical impulse in heart.
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| The electrical stimulation of depolarization results in what mechanical action repolarization = mechanical? | contraction...systole
relaxation...diastole
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| Describe the electromechanical circuit | SA node-AV node(delayed)-atria contract-(atria kick)vent filling-bundle of His-Purkinje fibers-vent contract-vent relax
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| pos/neg chronotrophy pos/neg dromotrophy pos/neg inotrophy | chr: incr HR
dro: conduction
ino: force of contraction
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| autonomic nervous system incl | sympathetic(adrenergic)/parasympathetic nerve fibers
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| sympathetic stimulation does what in cardiac Parasympathetic stimulation fibers do what to cardiac? | Sym:constricts peripheral vessels, incr BP
Para: decr HR, conduction, force of contraction, dilate aa, decr BP
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| Risk factors for dysrythmias | ischemia(not enuf O2) of heart muscle, hypoxia, electrolyte imbal, drug toxicity(Dig), conductions alter, reentry of pulses
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| ECG terms: Pwave? P-R Seg?, QRS complex? S-T seg? | Pwave: arterial depolarization, .06-.12s, SA node firing
P-R: end Pwave to beg. of QRS. Rep time needed for SA fire
QRS: Vent depolarization
S-T: end of QRS to start of T(elevated in MI, depressed in ischemia)
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| Twave? Q-T interval? Uwave? P-P int? R-R int? | Twave: repolarization of vent, atrial repolarization not visible, resting,
QT int: vent dep/rep, (prolonged =torsades de pointes, vent dys, twisting)
Uwave: rep of Purkinje fibers, hypokalemia w/ depressed ST seg
P-P: pwave to pwave
R-R: QRS to QRS
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| ECG grid paper moves at? lg box (5sm box) horizontal? lb box(5 box) vertically? How calculate HR | move at: 25mm/sec
hor: .20sec/5mm
vert: 5mm/0.5mv
Cal: cout # of QRS complexes in 6 sec strip and multiply by 10
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| Normal Sinus Rhythm | reg rate/rhythm. Rate: 60-100bpm
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| Sinus bradycardia? Sinus tachycardia? Sinus arrythmia? | rate: <60
rate: >100
rate: 60-100 but irregular
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| Atrial Dysrythmias: | PAC premature atrial complex, atrial flutter, atrial fibrillation
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| Premature atrial complex | PP interval short/long/short
Pwave hidden/buried in Twave
"skipped beat"
no tx needed if not more than 6 per min., stop caffeine
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| Atrial flutter | conduction defect in atrium,
rate: 250-400, vent rate: 75-150
"saw tooth" pattern/reg
more Pwave b4 QRS
tx unstable: cardioversion(reset)
tx stable: dilitiazem(CCB-reduce tetany), betablockers, dig(strength), verapamil, heparin/warfarin prevent clot
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| Atrial fibrillation | short dur(paroxysmal)/long, incr stroke/death
rate:350-600, vent rate: 120-200 ir
"quivering" throw clots
tx: can recover on own
med: amiodarone/ibutilide/procainamide, diltiazem, dig, warfarin, Prodaxa(no antedote), cardioversion/pacemaker
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| Junctional Dysrhythmias | Premature jx complex, jx rhythm, AV node reentry
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| Premature Junctional Complex | Impulse starts in AV node before next impulse reaches AV node
No Pwave
cause: dig tox, CHF, CAD
tx: same for PAC, none needed
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| Junctional Rhythm | SA node gone, so AV node is pacemaker
vent rate: 40-60
reg rhythm
No Pwave/inverted
QRS inverted(other cells firing it)
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| AV Node Reentry | AV node fire repeated impulse in same area
cause: caffeine/nicotine
tx: ablation(cauterize vessel) to break reentry of impulse, vagal manuevers, cardioversion
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| Conduction Disorders/AV blocks What is a block? | 1st Degree, 2nd degree type I, 2nd degree type II, 3rd Degree
block: impeding firing of SA node to AV node
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| 1st Degree AV Block | atrial impulse r thru AV node into vent at slower rate.
longer PR int, but constant
cause: CAD, dig
tx: if dig, then stop drug
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| 2nd Degree AV Block, Type I? Type II? | I: "Wenckebach",PR widens til QRS drops off, QRS norm
tx: not needed if perfusion is good(vent rate is adequate), atropine to incr HR, look at ejection fraction
II: reg, Wide/inverted QRS(vent fire on own), constant PR, more Pwaves, irr RR int
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| 3rd Degree AV Block | "complete", decr CO, irr. no atrial impulses, Atria/Vent beat ind., inverted QRS
more Pwaves than QRSs
tx: IV bolus Atropine, pacemaker
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| Ventricular Dysrthmias | Premature Vent Complex(PVC), Multifocal PVC, Ventricular Tachycardia(Vtach), ventricular fibrillation(VFib), asystole
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| Premature Ventricular Complex | most common, irr., wide QRS and diff cause diff cells firing vent from diff spots), bizarre QRS
tx: lidocaine IV push w/ D5W
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| Multifocal PCVs | Quadrigeminy: q 4th beat is PVC
trigeminy: q 3rd
bigeminy: q 2nd
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| Vtach | 3 or more PVCs in row(mtn peaks), emergency
reg rate: vent rate: 100-200
wide QRS, no Pwave(buried in QRS)
tx: stable: procainamide IV/lidocaine bolus(numb tissue so not fire)
unstable: cardioversion/ defibrill/amiodarone
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| Vfib | vent quivering, rate: >300
no Pwave, QRS, Twave
tx: defibrillation, Na bicarb for lactic acidosis
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| asystole | flatline, code
tx: IV bolus epi/atropine, Na bicarb
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| Diff bn cardioversion and defibrillation | defib: emergency if no pulse, lubricate paddles w/ specific jelly, CLEAR x 3, "not-sync"
cardio: synchronized with pt electrical current(QRS)
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| Pacemakers have two essential components Nsg intv? | Electronic pulse generator
pacemaker electrodes
intv: prevent inf, check battery
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| atrial kick | last part of diastole and vent filling, accounting for 25%-30% of CO
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| Meds to control persistant Atrial fibrillation | IV beta blockers or nondihydropyridine calcium channel blocker(diltiazem/verapamil)
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| Why is a pt put on heparin and warfarin for anticoagulation therapy? | Until warfarin level is therapuetic, defined as INR(interna'l normalized ratio) b/n 2-3.
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| What is monomorphic? polymorphic? | mon: have consistent QRS shape/rate
poly: varying QRS shape/rhythm
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| Assessment of rhythm strip in order | assess underlying rhythm, PR interval for block
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| Understanding what's happening with AV Block Type I Tx: | Ea atrial impulse takes longer time for conduction until one impulse is fully blocked.
Tx: incr HR to maintain norm CO
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| Nsg assessments for dysrhythmias | skin: pale/cool, edema, neck vein distention
lungs: crackles/wheeze
heart: S3/S4, murmurs, decr PP
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| What is universal code for pacemakers fx? | 1. chamber(s) paced: A/V/D
2.chamber sensed: A/V/D/O(off)
3.pacemaker response: I(inhibited)/T(triggered)
4.vary HR
5.
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| What is diff in inhibited and triggered? | inhibited: pacemaker beats only when pt heart doeesn't
triggered: pacemaker paces heart
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